Prolotherapy Seminar Report

July 22, 2004

Again from EDNF. I attended this class. It was very interesting. By the way, I

did ask for permission to copy these reports.

Prolotherapy: A Holistic Approach to Pain Management

Presented by: Speciale, D.O.

8612 Main St, ville, NY

Toll Free

www.drtimspeciale.com

Prolotherapy is a practice of restoring function and structure, thereby reducing

pain, to ligaments and joints. It is administered best by those in the field of

Osteopathy, as they have the most intensive, specialized training in the

structure of the human body (joints, bones, muscles & ligaments). A Doctor of

Osteopathy, or DO, goes thru the same medical training as a doctor, but also

takes additional curriculum in anatomy, nutrition and may have training in

mental health fields as well. Dr Speciale was invited to speak in Buffalo by his

own patient, who taught the aqua therapy classes, so he had experience and

insight into the EDS issues.

The theory of Holistic Medicine is that health is dependent on many aspects of

our lives: Physical, Spiritual, Mental, Financial, Occupational, Family,

Nutrition and Hormones. Imbalances in one area can cause stress in others,

leading to illness and away from " optimal health " . Optimal Health is also a

holistic concept that states that we can not be " cured " or perfect in health,

but we are capable of working TOWARDS what represents Optimal Health for each of

us. What is optimal for one person, may not be attainable for someone

else....but each of us can continue to strive to be " the best that we can be " .

Some PEARLS OF WISDOM:

1) Be Patient

2) There is a time to be aggressive and a time to be conservative.

3) Allow the human body to heal itself; it does a marvelous job if we allow it

to heal.

4) Do not harm

5) We want to heal everyone...it's just not possible. Some people don't want to

be healed. It has no bearing on your abilities.

6) Be open minded. Certain techniques, modalities and treatments work well for

one patient, but not on another.

7) We are always looking for panaceas..for something or some treatment that will

sure all; we should realize that there never will be just one cure-all.

8) Treat all disease as if it had the same cause..a lack of optimal health.

9) Don't get someone healthy too fast.

10) Do not make anyone healthier than they want to be.

11) Be thorough with the basics

12) The longer is takes to acquire an aliment, the longer it takes to get rid of

it

13) Know the boundaries of your knowledge. This requires great wisdom and

perception. Know when you are helpful and know when directing someone to another

therapy would be more helpful.

14) Treat the individual & not the disease.

A clean body (like we have at birth) starts with no toxins and optimum healing

ability. A state of OKness exists when toxic load is contained within the body's

storage areas. No overt symptoms are noticed. When Toxic load capacity is

exceeded, the result is illness.

Myths of treating injuries:

1) rest if good

2) Inflammation is bad

3) Ice is nice

4) Anti-inflammatory medication is good

5) It just takes time

6) Cortisone shots will help

7) The MRI will show the problem

8) They are just going to scope me

9) Surgery will fix the problem

10) After a bit of rehab, you'll be back to playing

11) If I wear my knee brace, I'll be fine

12) The trainer has my best interests at heart

13) My coach is looking out for me

14) The team physician is an orthopedist

15) You have pain because you aren't doing your exercises

16) Athletics, especially running, will give you arthritis

17) No pain, no gain

18) Just quit, you are never going to get any better

19) Stretching prevents injuries

20) Carbohydrates fuel fitness

HEAT VERSUS ICE

EFFECTS: HEAT: ICE:

Arterioles Dilate Vasoconstrict

Blood Supply to

Connective Tissues Increased Decreased

Metabolic Rate Increased Decreased

Number of Immune Cells

to Injured Area Increased Decreased

Joint Collagen Effects Relaxation Stiffness

Net Affect: Anabolic Catabolic

Conclusion.....Heat BETTER than Ice to Heal!

Ligament....a short, fibrous band which connects one bone with another or

supports an organ. He showed us pics of various areas where ligament strength is

important and areas where damage often occurs....pelvis, shoulder/scapula,

elbows, wrist, hips, knee, ankle/tarsus. Another chart showed the areas of the

head and neck where a weakness translates into referral pain in other body

areas! For instance, a weak ligament in the Cervical Vertebrae 4-5 area will

cause pain and weakness in the lateral arm & forearm & into the thumb, index and

middle finger! One set of vertebrae lower (6-7) will affect the medial arm &

forearm into lateral hand, ring and little finger. Additional charts called

HACKETT REFERRAL PATTERNS showed the related areas in pelvis, lumbar region,

hip, & low back.

The next groups of pages showed what an MRI sees in a spine, versus how a prolo

practitioner can locate the source of the pain with mild finger pressure. Then

there was a chart that compared the costs, false positives, time involved and

more of MRI versus that handy thumb diagnosis:

FALSE POSITIVE RATE (Conservative estimate)

MRI positive in Asymptomatic Middle-Aged Athlete

Area: MRI THUMB

Lower Back 64 0

Neck 50 0

Shoulder 54 0

Knee 62 0

Other factors:

Cost $1,200 Office Visit $$

Time Involved 45 mins 45 seconds

Ability to reproduce the pain None 100%

Enjoyment by clinician None Lots

Likelihood of progression to surgery Very High Very Low

He then discussed some of the history and development and the pioneers of prolo

and went into the mechanics. In simple terms, prolo stimulates the body to

repair painful areas. He charted how the NORMAL inflammatory response of the

body to injury involves the formation of Prostaglandins, started at the cellular

level. When cortisone is used (as well as many other anti-inflammatory drugs),

it interrupts this cycle, disrupting the production of " Archidonic Acid " . The

pain may be gone temporarily....but the body's attempt to heal itself is also

stopped! There was a graph of the time and stages of normal healing, where

inflammation lasts about 5 days, cells proliferate in the injured area for 42

days, and then the whole area remodels and recreates itself for up to 300-500

days, depending upon severity. He had slides of what normal muscle tissue looks

like before and after prolo treatments, showing increased fibroblasts in

response to various strengths of injections. There was also a progression graph

of time & response to treatment: 2-3 days of possible soreness and inflammation

after treatment, possible additional response 2-4 weeks later if healing stages

are still increasing, then the real strengthening takes place in the 4-6 week

period after treatment, after which time pain is re-evaluated. Depending upon

the person or injury, he indicated the average number of treatments varied from

2-10 in his patient population.

The solutions used were described, as well as the needles (30 gauge, VERY fine)

and why stronger solutions might be used....in patient is in worse shape, needs

faster relief, is far from the treatment office, etc. The most common, mildest

solutions are Osmotics (Dextrose), next are Irritants like P2G (Phenol, glucose

& Glycerin), then Particulates (ie, pumice) and Chemotactics (Sodium Morrhuate).

Eventually, Growth Factors might be useful in injections, but they are still

being studied for future clinical trials. The following table showed the

respective increase in strength between prolo injections and a saline-injected

control group:

PROLO SALINE % CHANGE

Ligament mass (mg) 132.2 89.7 44

Ligament thickness (mm) 1.01 .79 27

Ligament Mass Length (mg/mm) 6.45 4.39 47

Junction Strength (N) 119.1 93.5 28

CONCLUSION: Prolotherapy causes a statistically significant increase in ligament

mass and strength as well as bone-ligament junction strength.

Next, he illustrated with charts how weak ligaments lead to Arthritis. A

ligament weakens. leading to excessive joint movement (We KNOW that feeling!).

The joint bones start colliding, crunching & popping is heard, bone may overgrow

in some areas in an attempt to stabilize it, arthritis sets in & we start taking

the NSAIDS for the pain, which contribute to more ligament weaknesses. The cycle

keeps increasing.....prolo given in the area of the weakness stops the cycle!

(In my case, the bones/joints are too far gone....so catching the process early

IS imperative to save your joints!).

Additional comparison charts for possible treatments:

PROLO versus Arthroscopy:

PROLO ARTHRO

Stimulates repair yes no

Increases Collagen Strength yes no

Arthritis risk Decreased Increased

Return to activity Quick Slow

Rehab time Short Long

Exercise Encouraged Cautious

Costs Hundreds Thousands

Time in Procedure Minutes Hours

Instruments used Thin needles BIG scopes

PROLO VS Cortisone:

Effects on healing Enhanced Inhibited

Effect on Repair Enhanced Inhibited

Effects on Collagen Growth Enhanced Inhibited

Effects on Tendon Strength Enhanced Inhibited

Effects on Ligament Strength Enhanced Inhibited

Effects on Cartilage Growth Enhanced Inhibited

He had photos of surgery (YUCK!) versus prolo treatment & the results

after...the prolo looked MUCH nicer! He had tons of charts & illustrations of

how stuff like an instable neck, shoulder, spine or knee causes problems with

other body parts. He showed the progression of an unstable back to a completely

degenerated spine....and how exactly prolo could prevent such. His charts showed

the areas of injections, technique & angles in various body parts. He covered

the safety of prolo versus effects of degenerative conditions versus risk of

surgery, especially in EDS patients were surgery poses a higher risk. The cost

of traditional rehab methods was compared in an example to prolo.....traditional

PT & rehab over 4 months could be as high as $25,320, versus 2-10 prolo visits

in the same period for $175-$350 a session. He discussed one of his case

studies, a patient named Tim Doyle, one of the top-ranked racquetball players in

the world. Tim had injured his sacroiliac joint in a fall & NSAIDS and PT hadn't

helped after 2 years (and was not able to compete). After 6 sessions of prolo,

he was 100% fine & playing again. Then he discussed a patient with EDS who was

confined to a wheelchair. She visited his mentor, Dr Hemwall, and treated

virtually every joint in her body. She is now not only able to walk, but to run.

She takes periodic tune-up treatments to maintain her condition, because the

connective tissue doesn't heal itself properly otherwise.

After the presentation, Dr Speciale answered individual questions for an hour

more AFTER the session was over. I was impressed especially with his handling of

a patient who had prolo elsewhere & had a temporary adverse reaction. After

intensive questioning, he determined that the practitioner probably used an

overly deep and straight-in angle of injection in an area where a shallow,

angled approach would have been best. But it illustrated that even a " goof " in

prolo can heal easily, versus a major slip-up in surgery. Also, it was noted

that medical insurance for a prolo is 100s of times LESS than that of other

specialties due to the lack of damage suffered by patients over its 66+ year

documented history. I believe Dr Speciale mentioned having about 16 years in

practice in prolo, without a single adverse effect in a patient.

For more information, he invited us all to visit his website for info on the

board he is a member of and info on referrals to a practitioner in your area.

July 22, 2004

Gosh Cindy thanks!

That was great reading.

I am going to copy this via email to my GP (who is an osteopath) and see if

he knows someone out my way.

I did have a question.

Do they have statistics on EDS healing?

Did I miss that in my reading?

I have heard that prolotherapy can be counter productive on EDS ligaments.

Debbi

Prolotherapy Seminar Report

Again from EDNF. I attended this class. It was very interesting. By the way,

I did ask for permission to copy these reports.

Prolotherapy: A Holistic Approach to Pain Management

Presented by: Speciale, D.O.

8612 Main St, ville, NY

Toll Free

www.drtimspeciale.com

Prolotherapy is a practice of restoring function and structure, thereby

reducing pain, to ligaments and joints. It is administered best by those in

the field of Osteopathy, as they have the most intensive, specialized

training in the structure of the human body (joints, bones, muscles &

ligaments). A Doctor of Osteopathy, or DO, goes thru the same medical

training as a doctor, but also takes additional curriculum in anatomy,

nutrition and may have training in mental health fields as well. Dr Speciale

was invited to speak in Buffalo by his own patient, who taught the aqua

therapy classes, so he had experience and insight into the EDS issues.

The theory of Holistic Medicine is that health is dependent on many aspects

of our lives: Physical, Spiritual, Mental, Financial, Occupational, Family,

Nutrition and Hormones. Imbalances in one area can cause stress in others,

leading to illness and away from " optimal health " . Optimal Health is also a

holistic concept that states that we can not be " cured " or perfect in

health, but we are capable of working TOWARDS what represents Optimal Health

for each of us. What is optimal for one person, may not be attainable for

someone else....but each of us can continue to strive to be " the best that

we can be " .

Some PEARLS OF WISDOM:

1) Be Patient

2) There is a time to be aggressive and a time to be conservative.

3) Allow the human body to heal itself; it does a marvelous job if we allow

it to heal.

4) Do not harm

5) We want to heal everyone...it's just not possible. Some people don't want

to be healed. It has no bearing on your abilities.

6) Be open minded. Certain techniques, modalities and treatments work well

for one patient, but not on another.

7) We are always looking for panaceas..for something or some treatment that

will sure all; we should realize that there never will be just one cure-all.

8) Treat all disease as if it had the same cause..a lack of optimal health.

9) Don't get someone healthy too fast.

10) Do not make anyone healthier than they want to be.

11) Be thorough with the basics

12) The longer is takes to acquire an aliment, the longer it takes to get

rid of it

13) Know the boundaries of your knowledge. This requires great wisdom and

perception. Know when you are helpful and know when directing someone to

another therapy would be more helpful.

14) Treat the individual & not the disease.

A clean body (like we have at birth) starts with no toxins and optimum

healing ability. A state of OKness exists when toxic load is contained

within the body's storage areas. No overt symptoms are noticed. When Toxic

load capacity is exceeded, the result is illness.

Myths of treating injuries:

1) rest if good

2) Inflammation is bad

3) Ice is nice

4) Anti-inflammatory medication is good

5) It just takes time

6) Cortisone shots will help

7) The MRI will show the problem

8) They are just going to scope me

9) Surgery will fix the problem

10) After a bit of rehab, you'll be back to playing

11) If I wear my knee brace, I'll be fine

12) The trainer has my best interests at heart

13) My coach is looking out for me

14) The team physician is an orthopedist

15) You have pain because you aren't doing your exercises

16) Athletics, especially running, will give you arthritis

17) No pain, no gain

18) Just quit, you are never going to get any better

19) Stretching prevents injuries

20) Carbohydrates fuel fitness

HEAT VERSUS ICE

EFFECTS: HEAT: ICE:

Arterioles Dilate Vasoconstrict

Blood Supply to

Connective Tissues Increased Decreased

Metabolic Rate Increased Decreased

Number of Immune Cells

to Injured Area Increased Decreased

Joint Collagen Effects Relaxation Stiffness

Net Affect: Anabolic Catabolic

Conclusion.....Heat BETTER than Ice to Heal!

Ligament....a short, fibrous band which connects one bone with another or

supports an organ. He showed us pics of various areas where ligament

strength is important and areas where damage often occurs....pelvis,

shoulder/scapula, elbows, wrist, hips, knee, ankle/tarsus. Another chart

showed the areas of the head and neck where a weakness translates into

referral pain in other body areas! For instance, a weak ligament in the

Cervical Vertebrae 4-5 area will cause pain and weakness in the lateral arm

& forearm & into the thumb, index and middle finger! One set of vertebrae

lower (6-7) will affect the medial arm & forearm into lateral hand, ring and

little finger. Additional charts called HACKETT REFERRAL PATTERNS showed the

related areas in pelvis, lumbar region, hip, & low back.

The next groups of pages showed what an MRI sees in a spine, versus how a

prolo practitioner can locate the source of the pain with mild finger

pressure. Then there was a chart that compared the costs, false positives,

time involved and more of MRI versus that handy thumb diagnosis:

FALSE POSITIVE RATE (Conservative estimate)

MRI positive in Asymptomatic Middle-Aged Athlete

Area: MRI THUMB

Lower Back 64 0

Neck 50 0

Shoulder 54 0

Knee 62 0

Other factors:

Cost $1,200 Office Visit $$

Time Involved 45 mins 45 seconds

Ability to reproduce the pain None 100%

Enjoyment by clinician None Lots

Likelihood of progression to surgery Very High Very Low

He then discussed some of the history and development and the pioneers of

prolo and went into the mechanics. In simple terms, prolo stimulates the

body to repair painful areas. He charted how the NORMAL inflammatory

response of the body to injury involves the formation of Prostaglandins,

started at the cellular level. When cortisone is used (as well as many other

anti-inflammatory drugs), it interrupts this cycle, disrupting the

production of " Archidonic Acid " . The pain may be gone temporarily....but the

body's attempt to heal itself is also stopped! There was a graph of the time

and stages of normal healing, where inflammation lasts about 5 days, cells

proliferate in the injured area for 42 days, and then the whole area

remodels and recreates itself for up to 300-500 days, depending upon

severity. He had slides of what normal muscle tissue looks like before and

after prolo treatments, showing increased fibroblasts in response to various

strengths of injections. There was also a progression graph of time &

response to treatment: 2-3 days of possible soreness and inflammation after

treatment, possible additional response 2-4 weeks later if healing stages

are still increasing, then the real strengthening takes place in the 4-6

week period after treatment, after which time pain is re-evaluated.

Depending upon the person or injury, he indicated the average number of

treatments varied from 2-10 in his patient population.

The solutions used were described, as well as the needles (30 gauge, VERY

fine) and why stronger solutions might be used....in patient is in worse

shape, needs faster relief, is far from the treatment office, etc. The most

common, mildest solutions are Osmotics (Dextrose), next are Irritants like

P2G (Phenol, glucose & Glycerin), then Particulates (ie, pumice) and

Chemotactics (Sodium Morrhuate). Eventually, Growth Factors might be useful

in injections, but they are still being studied for future clinical trials.

The following table showed the respective increase in strength between prolo

injections and a saline-injected control group:

PROLO SALINE % CHANGE

Ligament mass (mg) 132.2 89.7 44

Ligament thickness (mm) 1.01 .79 27

Ligament Mass Length (mg/mm) 6.45 4.39 47

Junction Strength (N) 119.1 93.5 28

CONCLUSION: Prolotherapy causes a statistically significant increase in

ligament mass and strength as well as bone-ligament junction strength.

Next, he illustrated with charts how weak ligaments lead to Arthritis. A

ligament weakens. leading to excessive joint movement (We KNOW that

feeling!). The joint bones start colliding, crunching & popping is heard,

bone may overgrow in some areas in an attempt to stabilize it, arthritis

sets in & we start taking the NSAIDS for the pain, which contribute to more

ligament weaknesses. The cycle keeps increasing.....prolo given in the area

of the weakness stops the cycle! (In my case, the bones/joints are too far

gone....so catching the process early IS imperative to save your joints!).

Additional comparison charts for possible treatments:

PROLO versus Arthroscopy:

PROLO ARTHRO

Stimulates repair yes no

Increases Collagen Strength yes no

Arthritis risk Decreased Increased

Return to activity Quick Slow

Rehab time Short Long

Exercise Encouraged Cautious

Costs Hundreds Thousands

Time in Procedure Minutes Hours

Instruments used Thin needles BIG scopes

PROLO VS Cortisone:

Effects on healing Enhanced Inhibited

Effect on Repair Enhanced Inhibited

Effects on Collagen Growth Enhanced Inhibited

Effects on Tendon Strength Enhanced Inhibited

Effects on Ligament Strength Enhanced Inhibited

Effects on Cartilage Growth Enhanced Inhibited

He had photos of surgery (YUCK!) versus prolo treatment & the results

after...the prolo looked MUCH nicer! He had tons of charts & illustrations

of how stuff like an instable neck, shoulder, spine or knee causes problems

with other body parts. He showed the progression of an unstable back to a

completely degenerated spine....and how exactly prolo could prevent such.

His charts showed the areas of injections, technique & angles in various

body parts. He covered the safety of prolo versus effects of degenerative

conditions versus risk of surgery, especially in EDS patients were surgery

poses a higher risk. The cost of traditional rehab methods was compared in

an example to prolo.....traditional PT & rehab over 4 months could be as

high as $25,320, versus 2-10 prolo visits in the same period for $175-$350 a

session. He discussed one of his case studies, a patient named Tim Doyle,

one of the top-ranked racquetball players in the world. Tim had injured his

sacroiliac joint in a fall & NSAIDS and PT hadn't helped after 2 years (and

was not able to compete). After 6 sessions of prolo, he was 100% fine &

playing again. Then he discussed a patient with EDS who was confined to a

wheelchair. She visited his mentor, Dr Hemwall, and treated virtually every

joint in her body. She is now not only able to walk, but to run. She takes

periodic tune-up treatments to maintain her condition, because the

connective tissue doesn't heal itself properly otherwise.

After the presentation, Dr Speciale answered individual questions for an

hour more AFTER the session was over. I was impressed especially with his

handling of a patient who had prolo elsewhere & had a temporary adverse

reaction. After intensive questioning, he determined that the practitioner

probably used an overly deep and straight-in angle of injection in an area

where a shallow, angled approach would have been best. But it illustrated

that even a " goof " in prolo can heal easily, versus a major slip-up in

surgery. Also, it was noted that medical insurance for a prolo is 100s of

times LESS than that of other specialties due to the lack of damage suffered

by patients over its 66+ year documented history. I believe Dr Speciale

mentioned having about 16 years in practice in prolo, without a single

adverse effect in a patient.

For more information, he invited us all to visit his website for info on the

board he is a member of and info on referrals to a practitioner in your

area.

July 22, 2004